Healthcare Provider Details

I. General information

NPI: 1457619611
Provider Name (Legal Business Name): NEW ENGLAND SLEEP THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1291 BOSTON POST RD SUITE 202
MADISON CT
06443-3476
US

IV. Provider business mailing address

1291 BOSTON POST RD SUITE 202
MADISON CT
06443-3476
US

V. Phone/Fax

Practice location:
  • Phone: 203-815-0385
  • Fax:
Mailing address:
  • Phone: 203-815-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIGON SONG
Title or Position: CEO
Credential: DDS
Phone: 646-369-6918